HomeMy Public PortalAbout9161 JAYLEE DR_Sewer_2/1/1954_cesspool DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
i ADDRESS Irl
IcITY ,
FOR APPLICANT TO FlL IN LOCALITY t -
BUILDING / rA NEAREST
ADDRESS l((� ��/ CROSSST.
LOCALITY i DISTRICs NO. S IALJNO. PERMIT NO.
S A _�NEAREST [' �Q� �
CROSS ST. / } RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL
ADDRESS USE ZONES OCCUPANCY ft1AP
BIC PG
CITY TEL.NO. I �
d.o
CONTRACTOR. CO.-IMP.-NO.
ADDRESSS� 3 3 ?l n JOB NO.
CITY Q TEL.NO'/ TRUNK PERMIT N0.
REGISTRATION NO. /�j l 7- COUNTY ROAD PERMIT NO.
LEGAL ! STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER Q $ 3.50 RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION,RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE
OER REFERENCEUPPLOWER
_ TYPE OF CONNECTIONLENGTH FROM
OWNERS PERMIT $ 1 00 Y. 'CURB' P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE 3- 4
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
"! DWELLING TO THE PUBLIC SEWER
SIGNED THIS--------------------DAY OF....................................._.-19...... NEW HOUSE SEWER
OWNER ORCONNECT ADDITIONAL
OWNERS AGENT-------------------_................................. - BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS..............._................................•---•....------------..................... AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL DRYWELL I�fT fs�l1AI�/!Jf/ �
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER. EPAI ,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESC,RI_BEQ__RYESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)E] CESSPOOLS C] -
SIGNATURE s
OF PERMITTEE_. t ._. _. Atc� !� � s '�...._.......
76A642A 663 7/53